THE VALUED VOICE

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IN THIS ISSUE

WHA Leads Broad Health, Business Coalition on Statewide COVID Public Service Announcement .................... 1

Medicaid Releases ED Copay Clarification ...................................... 1

Wisconsin Hospitals State PAC & Conduit Fundraising Approaches $200,000 .......................................... 2

HHS Announces New “Hot Spot” Payments, Including $79 Million for WI Hospitals ..................................... 2

Appeals Court Sides with Federal Government on Site-Neutral Payment Cuts ................................... 3

HealthCheck: What Providers Need to Know to Help Children ................. 3

Member Quality Spotlight: Ascension Wisconsin ........................ 5

CELEBRATING 100 YEARS: Wisconsin’s Hospital Rate-Setting Commission: How it Came to Be and its Sunset .... 6

WHA Leads Broad Health, Business Coalition on Statewide COVID Public Service Announcement WHA recruited and organized an impressive array of statewide health care, business and local government advocacy groups to produce and broadcast a statewide television public service announcement (PSA), which was unveiled July 20. The PSA features real people from health care, restaurant and grocery settings to emphasize the importance of wearing masks in public, washing hands regularly and maintaining social distance during the pandemic.

The coalition partners include WHA, the Wisconsin Restaurant Association, the Wisconsin Grocers Association, the Wisconsin Medical Society, the Wisconsin REALTORS Association, the Wisconsin Builders Association, the Wisconsin Counties Association and the Wisconsin Safety Council.

“As the state experiences an uptick in positive cases, we need to do all we can to keep the public healthy so hospitals and health systems don’t get overwhelmed,” WHA President and CEO Eric Borgerding said. “The coalition WHA gathered for this public message is important not only for public health, but for our state’s economic health, too – wearing masks, washing hands and keeping a smart distance are all important strategies that can help Wisconsin get through this pandemic.”

The PSA will continue its statewide run through Sunday, August 2.

Medicaid Releases ED Copay ClarificationThe Wisconsin Medicaid program now requires an $8 copay for nonemergency visits to the emergency department (ED) by certain Medicaid patients. The copay is part of a demonstration waiver approved by the federal Centers for Medicare & Medicaid Services in October 2018 and was included in 2017 Wis. Act 370, which the legislature passed in December 2018.

Although WHA continues to object to the copay policy, believing it does not accomplish the legislature’s goal of reducing the inappropriate use of emergency departments, WHA worked with the Wisconsin Department of Health Services (DHS) to mitigate members’ implementation concerns.

“As we have already done well before this policy was enacted into law, we will continue to work with the legislature and DHS on proven policies, like provider intensive care coordination programs, that actually accomplish the legislature’s

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EDUCATIONAL EVENTS

July 23, 2020

July 28, 2020Will there be a Doctor in the House? Physician Supply, Demand and Staffing in the Era of COVID-19Webinar

July 29, 2020CMS Hospital Conditions of Participation Made Easy 2020 – Part 1Webinar

Visit www.wha.org for more educational

opportunities

Click to view the PSA, running statewide through early August.

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intended goal to reduce inappropriate emergency department utilization,” WHA President and CEO Eric Borgerding said.

The $8 copay applies only to Medicaid patients who are considered childless adults, meaning they are between the ages of 19-64, are not pregnant, and they do not have dependent children living at home. There are several exceptions to the copay requirement, including that the Medicaid patient has reached the federal 5% limit on Medicaid cost share amounts.

Acknowledging hospitals’ EMTALA obligations, the Medicaid ED copay applies when all the following conditions are met:

• The $8 copay applies to the member.• The member did not meet the prudent layperson standard of a medical emergency.• The member sought and received additional post-stabilization care in the emergency department after being informed

of the $8 copay and the availability of alternative providers with lesser or no cost share.

There are additional details related to methods for verifying copay eligibility and other implementation issues available in the Medicaid program’s original ForwardHealth Update and in a ForwardHealth Update clarifications released this week. Hospitals should contact the HMOs with which they have contracts for details concerning contract issues and other implementation expectations.

Wisconsin Hospitals State PAC & Conduit Fundraising Approaches $200,000 See 2020 Contributor List

To date the 2020 Wisconsin Hospitals State PAC & Conduit campaign has raised $196,233 from 139 contributors. See a list of the 2020 contributors at the end of this newsletter. In this pivotal election year remember that elections matter, and participation is important.

Supporting candidates through contributions to the Wisconsin Hospitals State PAC and Conduit is one element of the Wisconsin Hospital Association’s integrated advocacy approach, which also includes directly lobbying elected officials and working to engage hospital constituents directly with their elected officials, such as HEAT Roundtables.

Participating in the political process is important to protect high-quality, high-value health care. The Wisconsin Hospitals State PAC & Conduit supports candidates who understand the important role Wisconsin hospitals and health systems have, both as leaders in care delivery and as essential employers within the communities they serve.

Join your health care peers in participating in this important advocacy program ensuring more state candidates who value health care are elected. Take a look at the list of contributors and make sure to add your name to the list. Contribute online at www.whconduit.com or by contacting Kari Hofer at 608-358-4054 or Nora Statsick at 608-239-4535.

HHS Announces New “Hot Spot” Payments, Including $79 Million for WI HospitalsThe U.S. Department of Health and Human Services (HHS) on July 17 announced details of how the second round of COVID-19 high-impact or “hot spot” hospitals payments would be distributed.

HHS released a breakdown showing nearly 1,000 hospitals across the country would receive a total of over $8.5 billion, and HHS has said as much as $10 billion may be distributed. Twelve Wisconsin hospitals will qualify for a total of $79 million in relief. Wisconsin fared much better under this round than it did under the first “hot spot” round where only two Wisconsin hospitals were eligible.

According to HHS, to be eligible for the funding a hospital must have recorded more than 161 COVID-19 cases as of June 10, 2020, and would receive $50,000 per eligible admission. Alternatively, hospitals that experienced a disproportionate intensity of COVID-19 admissions (exceeding the average ratio of COVID admissions per bed) may also be eligible.

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(Medicaid Releases ED Copay Clarification . . . continued from page 1)

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While this is welcome news, Wisconsin hospitals and health systems have received just over $1 billion total of the $115 billion in Provider Relief Funding distributed so far, despite experiencing more than $2.5 billion in lost revenue due to COVID-19 and facing continued future financial uncertainty. WHA continues to advocate with the Wisconsin congressional delegation for needed financial assistance for Wisconsin hospitals and health systems as Congress continues its work on its next COVID package. For more information, contact WHA Director of Federal and State Relations Jon Hoelter.

Appeals Court Sides with Federal Government on Site-Neutral Payment CutsThe U.S. Court of Appeals for the District of Columbia Circuit on July 17 sided with the Department of Health and Human Services in a lawsuit challenging the authority of the government to decrease payments to off-campus hospital outpatient departments. This reversed a district court decision from 2019 that had previously ruled the department’s actions unlawful.

At issue has been the department’s so-called “site-neutral” payment policy, which reduced hospital payments for clinic visit services delivered at off-campus hospital outpatient departments (HOPDs). In the 2015 Bipartisan Budget Act, Congress reduced payments for new HOPDs to put them in line with non-hospital sites paid under the physician fee schedule. At the same time, Congress grandfathered existing HOPDs at the previous, higher rate. Nevertheless, in the 2019 OPPS rule, the Centers for Medicare & Medicaid Services (CMS) alleged that a statute allowing the agency to reduce unnecessary utilization of services also grants it the authority to reduce payments to off-campus HOPDs for clinic visit services.

The prior decision from the district court had ruled that CMS could not use its unnecessary utilization of services authority in a manner that conflicts with the statute Congress passed directing how payments must be made under the outpatient rule. The Court of Appeals decision, however, cited a previous court case from 1984 that gave the federal government wide deference on judicial review of its Medicare statute.

WHA has made this topic a priority advocacy issue, enlisting support from members of Wisconsin’s congressional delegation in a 2018 letter to CMS expressing concern over the policy. WHA noted the policy fails to take into account the fact that hospitals have historically been paid at higher rates in order to offset the higher costs they face for running 24/7 emergency departments, facing a higher regulatory standard and generally treating sicker, more medically-complex patients. The impact of the original rule proposed by CMS in 2018 was projected to cost Wisconsin hospitals and health systems around $440 million over 10 years.

The American Hospital Association and plaintiffs noted their disappointment in reaction to the decision and stated they would be exploring further appeals options. WHA will also continue its advocacy efforts and examine opportunities for Congress to provide a legislative fix. For more information, contact WHA Director of Federal and State Relations Jon Hoelter.

HealthCheck: What Providers Need to Know to Help ChildrenBy Attorney Megan L. Sprecher, End Domestic Abuse WisconsinWhat is HealthCheck?A federal law called Early Periodic Screening Diagnosis and Treatment (EPSDT) requires state Medicaid programs to provide screening, diagnosis, and treatment services for members under 21 years of age, including dependent children and childless adults. In Wisconsin, EPSDT is called “HealthCheck.” The goal of HealthCheck is to obtain the best results for children by preventing, diagnosing, and treating health problems as early as possible.

Although Congress created EPSDT over 50 years ago, it is not well known. HealthCheck is underutilized for a variety of reasons, including lack of provider and community knowledge and prior authorization process/denials.

How Can HealthCheck Help Wisconsin Children?

• “Well Child” Checks and Interperiodic Screens are available without prior authorization and include comprehensive health and developmental history (including behavioral health), comprehensive physical exam, vision and hearing screens, oral assessment and referral to a dentist, laboratory tests, and vaccines. HealthCheck follows a schedule for periodic examinations outlined by the American Academy of Pediatrics.

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(HHS Announces 2nd Round of “Hot Spot” Payments . . . continued from page 2)

GUEST COLUMN

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• Outreach and Case Management Services are available without prior authorization and include scheduling and coordinating transportation to appointments and arranging referrals and follow up appointments.

• HealthCheck “Other Services” generally require prior authorization and include medically necessary services not typically covered by Wisconsin Medicaid. This can include services such as durable medical equipment, therapies (such as speech, hearing, occupational, and physical), in home and day treatment mental health services, home health services, hearing aids, orthodontia, rehabilitation services, medications (both prescription and over-the-counter), some dental services, and more. Prior authorization requests should include a clear explanation of how the requested service/product is medically necessary.

When is a Requested Service “Medically Necessary” Under HealthCheck?

The definition of “medically necessity” is broader under HealthCheck. The requested service is “medically necessary” under HealthCheck if it is likely to correct or ameliorate the child’s condition, including maintaining current status or preventing regression. The decision is made on a case-by-case basis on the needs of the child. The requested service must also meet the medical necessity standards cited in Wis. Admin. Code § DHS 101.03(96m).

What if a Prior Authorization is Denied?

If a prior authorization is denied, the child’s family or an authorized representative may appeal. Families may wish to ask for representation or assistance either through their healthcare system or a legal services agency such as Legal Action of Wisconsin or Wisconsin Judicare.

Where Can I Find More Information About HealthCheck?

• WI DHS video for providers • WI DHS Intro to HealthCheck• WI DHS brochure for parents to learn more about supporting their child through HealthCheck• ABC for Health HealthCheck video• ABC for Health HealthCheck info page

(Guest Column: HealthCheck: What Providers Need to Know to Help Children . . . continued from page 3)

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Member Quality Spotlight: Ascension WisconsinReducing sepsis mortalitySpecial Note: Many WHA members proud of their quality improvement efforts had prepared special poster presentations that were to be displayed in the Capitol Rotunda during WHA’s Advocacy Day 2020, which was cancelled due to the COVID-19 pandemic. WHA is pleased to highlight these efforts in today’s and future editions of The Valued Voice.

With sepsis identified as a clinical priority in 2019, Ascension Wisconsin set out to reduce sepsis mortality at their hospital campuses and health care facilities. Through extensive collaboration among the 19 Ascension hospitals in Wisconsin, they implemented use of a sepsis toolkit with a goal to reduce mortality due to sepsis by 10% and to drive standardization of best practices and treatment plans.

Each hospital/region of hospitals organized a local implementation sepsis team. Screening tools for early recognition were developed and implemented, along with a standard treatment order set for the emergency department and inpatient units. Incorporation of early recognition of the signs and symptoms of sepsis into a rapid response process and the development and implementation of a standard mortality review process were significant strategies in reducing sepsis mortality. Ascension Wisconsin found the key to success was associate, provider and patient engagement. Methods used in this Surviving Sepsis campaign included education through in-person training, web-based training, newsletters, sharing personal stories and bundle feedback. An important educational strategy with providers was sharing data that included order set usage and its correlation with mortality.

Through their efforts, Ascension Wisconsin achieved their goal of reducing mortality due to sepsis. There is continued monitoring of SEP-1 bundle compliance and sepsis mortality to sustain their progress.

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Reaction from Local State Legislators:

“Ascension Wisconsin’s innovative work lowering the rate of sepsis mortality is an amazing example of Ascension’s collaborative approach to patient care. Work like this is what makes our state one of the

highest quality health care states in the U.S. Thank you to the quality leaders across Ascension Wisconsin for your work on sepsis and the care and effort you put into your work every day. Congratulations on this well-deserved honor! ” – State Rep. Greta Neubauer (D-Racine)

“I would like to congratulate the amazing leaders across Ascension Wisconsin hospitals for being featured by the Wisconsin Hospital Association for their work lowering the rate of sepsis mortality in

Ascension hospitals. Wisconsin continues to really earn its position as one of the highest quality health care states in the country, and I am proud of the innovative work Ascension does to help us stay at the forefront of health care advancement.” – State Rep. Mary Felzkowski (R-Irma)

Rep. Greta Neubauer

Rep. Mary Felzkowski

Click on image to enlarge this poster presentation

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Wisconsin’s Hospital Rate-Setting Commission: How it Came to Be and its Sunset

From 1972 - 1983, WHA dealt with a variety of political and policy pressures related to hospital costs and various proposals to address the issue. Events included the creation of a voluntary Rate Review Program; attempts by the Wisconsin Legislature to make rate setting mandatory; the addition of the State of Wisconsin as a partner in the Rate Review Program; negotiation of a major revision of Rate Review to strengthen it; initial opposition, then support by the Wisconsin Hospital Association for the revised program; and finally, establishment of the Wisconsin Hospital Rate-Setting Commission.

The Commission became effective January 1, 1985. It represented yet another

approach to a decade-long effort in Wisconsin to address hospital costs.

The story is a complex one that encompasses a variety of initiatives and events. WHA’s Rate-Setting Commission booklet gives a development-by-development

description of how WHA navigated the times and how the Wisconsin Hospital Rate-Setting Commission came to be.

Many health care issues develop over years, not months – and that was certainly the case with the Hospital Rate-Setting Commission. With the election of Governor Tommy G. Thompson in 1986, WHA had the opportunity to work with a new administration more philosophically inclined to support a non-regulatory approach to containing health care costs. With WHA’s strong support (including this folder of information created by WHA in 1986 to make the case of allowing the HRSC to sunset in 1987), the Hospital Rate-Setting Commission sunset on June 30, 1987. A health care data mandate was enacted in its place to frame a less regulated, more competitive health care industry.

You can read more about this saga in the 1986 WHA Annual Report from WHA Chair Joe Neidenbach, including comments from Governor Thompson and WHA Chair-Elect Ed Howe.

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1986 WHA Annual Report

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WHA HRSC folder of information

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Political Action Fundraising Campaign Contributors

Rohrbach, Dan Southwest Health Rose, Laura Wisconsin Hospital AssociationSchimmers, Heather Ascension Wisconsin

Contributors $1,000 to $1,499

Curran-Meuli, Jane Monroe Clinic, a member of SSM HealthEdwards, Gordon Marshfield ClinicHartberg, David Vernon Memorial HealthcareHung, Karen Ascension WisconsinKeddington, Richard Watertown Regional Medical CenterLevin, Jeremy Rural Wisconsin Health CooperativeLindberg, Steve Mayo Clinic Health System - Red CedarNondorf, Kyle SSM St. Mary’s Hospital MadisonSchafer, Mike Spooner Health Sohn, Jonathan Ascension WisconsinThornton, Eric SSM St. Mary’s Hospital JanesvilleVan Meeteren, Robert Reedsburg Area Medical CenterWaldoch, Tim Ascension Wisconsin

Contributors $500 to $999

Aulik, Juli UW HealthBarth, Andrew Aspirus Langlade HospitalBloch, Jodi Children’s WisconsinBreen, Melissa Marshfield ClinicCox, Sharon Beloit Health SystemDeGere, Michael SSM Health - Wisconsin, Inc.Dexter, Donn Mayo Clinic Health System - Eau ClaireElkins, Kelly Ascension Columbia St. Mary’sHorvath, Joanne ThedaCareKharbat, Mohammad SSM Health - Wisconsin, Inc.Larson, Leigh Ann Wisconsin Hospital AssociationLarson, Peg Ascension Mercy HospitalMcCawley, Thomas Beloit Health SystemNelson, James Fort HealthCareNewman, John Aurora Medical Center - OshkoshOttenbaker, David SSM Health - Wisconsin, Inc.Peterson, Doug AdventHealth DurandPrise, Eric Tomah HealthRoesler, Bruce The Richland HospitalRude, Nels The Kammer GroupSchnedler, Lisa Upland Hills HealthSchubring, Randy Mayo Clinic Health System - Eau C laireSexton, William RetiredSommers, Craig SSM - St. Mary’s Hospital MadisonSprecher, Lon ConsultantStatsick, Nora Wisconsin Hospital AssociationTischer, Jesse Aspirus, Inc.Voelker, Thomas Aspirus Riverview Hospital & ClinicsWilliams, Janice WHA Information CenterWolters, Brad Marshfield Clinic Health System

Contributors $1 to $499

Abey, Michelle Stoughton HealthBorchert, Barry Reedsburg Area Medical CenterBrabant, Chris HSHS St. Clare Memorial HospitalByrne, Frank RetiredCliffe, Elizabeth Ascension WisconsinCompetente, Brian WHA Information CenterCronrath, Corey Marshfield Medical Center - Eau ClaireDettman, Amy Bellin Health SystemDux, Larry Froedtert & MCW Community Memorial Hospital CampusFerrigno, Sandra SSM Health Wisconsin, Inc.Fischer, Deborah Bellin Health SystemFleuette, Laurie Wisconsin Hospital AssociationGlenn, Kathi SSM - St. Mary’s Hospital Janesville

Contributors 10,000+ (Leaders Circle)

Borgerding, Eric & Dana Wisconsin Hospital AssociationSize, Tim & Pat Rural Wisconsin Health Cooperative

Contributors $5,000 to $7,499 (Leaders Circle)

Boatwright, Damond SSM Health WisconsinJacobson, Catherine Froedtert & The Medical College of WisconsinKammer, Peter The Kammer GroupMeyer, Daniel Aurora BayCare Medical Center - Green BayOlson, David & Joanne Alig Froedtert & The Medical College of Wisconsin & Wisconsin Hospital AssociationSherry, Bernie Ascension WisconsinTroy, Peggy Children’s WisconsinTurney, Susan Marshfield Clinic Health SystemWoleske, Chris Bellin Health System

Contributors $3,000 to $4,999 (Platinum Club)

Decker, Michael Divine Savior HealthcareHarding, Ed Aurora Medical Center - Bay AreaHeywood, Matthew Aspirus, Inc.Kachelski, Joe Wisconsin Statewide Health Information NetworkMettner, Michelle Children’s WisconsinNatzke, Ryan Marshfield Clinic Health SystemNewson, Reginald Ascension WisconsinO’Brien, Kyle & Laura Wisconsin Hospital AssociationPandl, Therese RetiredPotter, Brian Wisconsin Hospital AssociationRussell, John Prairie Ridge HealthSchulze, Connie UW HealthStandridge, Debra RetiredStanford, Matthew Wisconsin Hospital AssociationStarmann-Harrison, Mary Hospital Sisters Health SystemWallace, Michael Fort HealthCareZenk, Ann Wisconsin Hospital Association

Contributors $2,000 to $2,999 (Gold Club)

Brenton, Stephen Froedtert HealthDibbert, Beth Wisconsin Hospital AssociationGrapentine, Mark & Wendy Wisconsin Hospital AssociationGrebe, Michael Advocate Aurora HealthGustafson, Andrew & Sara SSM Health WisconsinHanus, Andrew Advocate Aurora HealthHofer, Kari Wisconsin Hospital AssociationLevin, Jeremy Rural Wisconsin Health CooperativeLewis, Gordon Burnett Medical CenterMcKevett, Timothy Beloit Health SystemWhite-Jacobs, Mary Beth Black River Memorial Hospital

Contributors $1,500 to $1,999 (Gold Club)

Anderson, Sandy HSHS Sacred Heart HospitalBachleitner, Joan Ascension WisconsinBagnall, Andrew HSHS WisconsinBeirl, Luke Hayward Area Memorial HospitalBirschbach, Nancy SSM Health - St. Agnes HospitalDeGroot, Dan Stoughton HealthDietsche, James Bellin Health SystemEuclide, Jeff Marshfield Medical Center - LadysmithFrancisco, Margo SSM Health WisconsinFroemming, Lisa Ascension Columbia St. Mary’s HospitalHilt, Monica Ascension St. Elizabeth HospitalHoelter, Jon & Elizabeth Wisconsin Hospital AssociationKaufman, Mark Wisconsin Hospital AssociationKluesner, Kevin Ascension St. Joseph HospitalLeitch, Laura Wisconsin Health Law & Policy, LLCMueller, Jennifer WHA Information CenterNorell, Brett Holy Family Memorial, Inc.

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(Political Action Fundraising Campaign Contributors . . . continued from page 7)

Hale, Anne Bellin Health SystemKoebke, Troy Bellin HospitalLally, David HSHS St. Clare Memorial HospitalLindfors, Teresa Stoughton HealthLuehring, Sally HSHS - St. Vincent HospitalLuskin, Ronald SSM - St. Mary’s HospitalMarquardt, Amy Froedtert & The Medical College of WisconsinMays, Laura Stoughton HealthMeicher, John SSM - St. Mary’s Hospital MadisonMurphy, Kayla SSM - St. Mary’s Hospital Janesville Obermiller, Susan Bellin Health SystemOungst, Laurie Howard Young Medical CenterPeiffer, Susan HSHS Sacred Heart HospitalRandles, Julie SSM Health St. Clare Hospital - BarabooRoundy, Ann Prairie Ridge HealthSelvick, Carl Fort HealthCareShorter, Tom Husch BlackwellVergos, Katherine St. Agnes HospitalWalker, Troy SSM Health St. Clare Hospital - BarabooWymelenberg, Tracy Advocate Aurora HealthWysocki, Scott SSM - St. Clare Hospital & Health Services

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